Reflecting back, it was interesting day. All of the people were very nice that I had an encounter with, but I had to deal with a constant smell of smoke. Even if they weren’t smoking in the building, there were so many employees that did smoke you could smell it in there. This was also constant in the houses we were visiting so I ended up leaving with a headache unfortunately. I think that’s where my golden nugget comes into play though. Even though, you might not agree with how they live their lives, it’s still your duty as their nurse to take care of them.
1. Identify the purpose and functions of the agency. Tennessee Quality homecare provide nurse care in the home setting. They offer care whether you are suffering a short-term illness or disability, or need more advanced care for a long period of time. They care all the way from newborns to seniors, seeing mostly seniors though. 2. Identify the implications of Health People 2020 for the aggregate served. An objection by Healthy People 2020 is “OA-11 Reduce the rate of emergency department (ED) visits due to falls among older adults”.
Jake stated that, along with their assessment safety is a huge part of their job, and even though they’re not there are all the time they still have to do their part to lessen the patient’s chance of falling. 3. Compare and contrast conducting a home visit with observing a med-surg nurse. Home health is obviously going to be very similar to my experience to Hospice. They do a little more in depth of an assessment when they are being seen though, which is understandable. Something that I didn’t mention before is you never really know what kind of environment you’re going to walk into.
One of the nurses had mentioned that there was a house that had a dog that would bite just like at Hospice, so you have to be careful. That’s definitely not something you have to deal with in the hospital. With home home health, it’s similar to the hospital, in the way that you might have the for a long time, or they might just need care while they’re recovering. 4. Identify health problems of the population served. Tobacco Use was definitely one that was evident her. One of the girls that I was talking to at the office said she needed a day off and Nancy asked her why.
She said it was because she thinks her brother has lung cancer. Her brother couldn’t have been older than 35 and she said he had been smoker since he was only 7. As I mentioned before, the smell of cigarettes were also in every house and in the Tennessee Quality Homecare building 5. Discuss levels of prevention and give an example of each level implemented by the home health/hospice nurse. Primary: Since smoking is huge in this area’s population, education about not smoking. Secondary: Treating a UTI, Once it’s found in the urine sample.
Tertiary: Management of Chronic Disease such as Diabetes. . Compare and contrast the legal and ethical issues encountered by the nurse. My mother is a home health nurse and she has come into some ethical issues before such as the patient believing she should clean the house. When she first began home health nursing she wasn’t really sure what to do so she said yes. They had her on a chair dusting and doing other housework. It was very demining and it got to a point to where it was getting in the way of taking care of the patient. She eventually talked to the patient and explained, that was not was she was there.
Assessing is always going to be a legal issue but probably more in the med-surg area. Those patients are usually in the worse shape and need much more care. Home health nurses are still held to the same standard though. 7. Evaluate health care availability, accessibility, accommodation, affordability, and acceptability of the aggregate. This is also relatively the same as when I went with hospice. The patients were in very rural areas. Most of them had some form of caregiver, whether it was a family member or a CNA that came in, but insurance paid for home health to also come in.
I got to Tennessee Quality Homecare around 0750. None of the nurses were there yet so I waited in the conference room. When everybody got there, they had a meeting scheduled. The meeting was to reassign patients to nurses. Apparently, they were having an issue with nurses driving all around to assess patients. It took them until 1000 but they were able to divide all the patients around. At the very beginning of the meeting though, Mrs. Nancy had an exercise that she had everybody participate in, including me. She wanted everybody to write down five aspects of home health care that were essential for it to run smoothly.
My five were : 1) Communication 2)Positive environment 3) Working with each other’s personalities 4) Working with patient’s schedules and 5)Patients. After assigning patients was finished, Nancy assigned me with Jake and he was a non smoker which was pleasant. Another topic that was discussed in the meeting, was how they were short staffed and looking for another nurse. They had two full time and a PRN but they were growing immensely. Nancy discussed the idea of adding on another PRN or hiring a full time which she said would be the better option.
I talked to Jack about this later in the car and he said they’ve actually been talking about that for a few months but nothing has been done yet. After the meeting was over we went back to Jack’s desk. He had some last minute paperwork from the day before to get done, so he did that first. It was about 1030 when we left. He had a patient with an elevated WBC so we headed there first. He wouldn’t have been seeing him usually but the doctor’s office prescribed him Gentamicin and we needed to check his vital signs. Jake let me give the shot and then he got his vital signs. All of his vital signs were good and we were ready to go.
We were headed to the next house, which was an elderly woman suffering from hip surgery. Jake had me take her vital signs while he did his assessment questions. He asked her questions such as, if her bowels were moving, how her pain level was, and if she was getting around okay. The only question the patient’s family had for Jake was if she could walk with her walker on the concrete to get some exercise. They said there was a neighbor that would be able to help her out there and could catch her if she began to fall. Jake said that would be fine but not to overdo it too soon.
The next house we went to was definitely out in the country. It was not the best living condition and he had a lot of pressure. Jake informed me though, that he had a very good care taker that applied the medicine when she needed to, changed the bandages, and kept them clean. When we got there there was much improvement. During the assessment, we had to deal with a lot of cats and dogs jumping around us. It was sometimes distracting, but we managed. The next house we went was about twenty minutes away from Tennessee Quality Homecare and this was going to be his last stop.
This was a man who had a stroke and it had affected his entire left side. When we had gotten there, his wife was feeding him. She was his main caretaker but he also had CNA that helped out as well. I took his vital signs and then Jake did his assessment. The patient didn’t talk during the entire assessment, so Jake geared his questions towards his wife. I think this mostly had to do with the fact that he was eating. Jake had two more houses but they were on his way home, so he took me back to the office. When we had gotten back almost, those who smoked were taking a smoke break outside.
Jake stopped to talk to one of them and she just kept smoking, like we were standing there which was a little hard to deal with. I was glad when Jake was ready to go inside. He asked me what I wanted to do for the rest of my time and I told him I could shadow somebody, if they were available. He said I could shadow Ashley, who is there clinical manager. She actually graduated from Freed in 2011 and was very helpful. She talked to me a little about coding and how they have to communicate the doctors. She gave an example using the patient we saw this morning.
She got a notification that that patient’s WBC’s were high and so she called the doctor’s office and the doctor ordered gentamicin for him. Ashley then communicated that we needed to go the doctor’s office to pick up the medicine. I hadn’t eaten yet and nobody had mentioned anything about food so I asked if I could run to Taco Bell and they were definitely okay with that. I took about ten minutes to get taco bell and then brought my food back to observe more. Another person that sits in the same office as Ashley, is John. He is also a former nurse but he just works PRN and serves more of a case managment position.
Jake explained in the care previously that all of those people had only recently gotten into those positions. That became somewhat obvious when certain situations arose. There would be a questions about filing or coding and nobody would actually know the answer. They had books on hand for different coding questions and people they could consult. Jake said the turnover rate was pretty high in that agency which was frustrating at times. Jake, himself is relatively new only being there for about six months. It was about 1540, so I decided to head out.